a client diagnosed with schizophrenia is slow to respond and appears to be listening to unseen others which medication should a nurse expect a physici a client diagnosed with schizophrenia is slow to respond and appears to be listening to unseen others which medication should a nurse expect a physici
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NCLEX RN Exam Review Answers

1. A client diagnosed with schizophrenia is slow to respond and appears to be listening to unseen others. Which medication should a nurse expect a physician to order to address this type of symptom?

Correct answer: Risperidone (Risperdal) to address the positive symptom

Rationale: The correct medication to address the symptom described, where the client is slow to respond and appears to be listening to unseen others, is Risperidone (Risperdal). Risperidone is an atypical antipsychotic that is commonly used to manage positive symptoms of schizophrenia. Positive symptoms can include hallucinations, delusions, and disorganized thinking. Haloperidol (Haldol) and Clozapine (Clozaril) are typically used for addressing negative symptoms, such as lack of motivation or social withdrawal. Clonazepam (Klonopin) is a benzodiazepine primarily used for anxiety disorders and seizures, not for addressing symptoms of schizophrenia.

2. Sinusitis is caused by:

Correct answer: Any of the above

Rationale: Sinusitis can be caused by bacteria, viruses, or fungi. While bacterial infections are the most common cause, viral or fungal infections can also lead to sinusitis. Therefore, the correct answer is 'Any of the above.' Choices A, B, and C are incorrect because they only represent individual causes of sinusitis, whereas choice D encompasses all possible causes.

3. The nurse prepares a patient with a left-sided pleural effusion for a thoracentesis. How should the nurse position the patient?

Correct answer: D: Sitting upright with the arms supported on an overbed table

Rationale: The correct position for a patient with a left-sided pleural effusion undergoing thoracentesis is sitting upright with the arms supported on an overbed table. This position helps increase lung expansion, allows fluid to collect at the lung bases, and expands the intercostal space making access to the pleural space easier. Placing the patient supine, in a high-Fowler's position, or on the right side with the left arm extended above the head could increase the work of breathing for the patient and complicate the thoracentesis procedure for the healthcare provider.

4. An emergency department nurse is performing an assessment on a child with a suspected diagnosis of intussusception. Which assessment question for the parents will elicit the most specific data related to this disorder?

Correct answer: Can you describe the type of pain that the child is experiencing?

Rationale: The correct answer is asking the parents to describe the type of pain the child is experiencing because a report of severe colicky abdominal pain in a healthy, thriving child between 3 and 17 months of age is the classic presentation of intussusception. Typical behavior includes screaming and drawing the knees up to the chest. This specific question helps in identifying the key symptom of intussusception. Choices A, B, and C are important aspects of a health history but are not specific to the diagnosis of intussusception. Food allergies, bowel movements, and recent food intake are relevant for a comprehensive assessment but do not directly relate to the specific symptoms of intussusception.

5. What does the 'B' in the SBAR acronym stand for?

Correct answer: A: Background

Rationale: The 'B' in the SBAR acronym stands for Background. SBAR is a standardized communication tool used in healthcare to effectively communicate critical information. In this context, 'Background' refers to providing relevant information about the patient's history, current status, and any other pertinent details. This information helps ensure clear and concise communication between healthcare providers, enhancing patient care. Choice B, 'Basic,' is incorrect as the 'B' specifically emphasizes the detailed background information. Choices C and D, 'Beginning' and 'Break,' are not accurate in the context of the SBAR communication tool.

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